Endocarditis infecciosa: morbimortalidad en Chile: resultados del estudio cooperativo nacional de endocarditis infecciosa, ECNEI, 1998-2002 / Mortality and complications of infective endocarditis in Chile: results of the national cooperative study of infective endocarditis, 1998-2002

RESUMO

Infective endocarditis is a severe condition, with a mortality that fluctuates between 16 and 25 percent in the Metropolitan area of Chile. Aim: To perform a prospective assessment of clinical and microbiological features of patients with infective endocarditis in Chile. Material and methods: Collaborative study of regional hospitals in the whole country and teaching hospitals in Santiago. Patients with a possible or definitive infective endocarditis, according to Duke's criteria, were included in the protocol and a structured data entry form was completed. Results: Three hundred twenty one patients (65 percent male, mean age 49ñ16.5 years) were studied. According Duke's criteria, 89 percent had a definitive and 11 percent a possible endocarditis. The subacute form occurred in 64 percent of patients. The most frequent predisposing cardiopathies were rheumatic in 25 percent, prosthetic valves in 15 percent and congenital in 13 percent. There was no evidence of cardiopathy in 20 percent. Twenty percent of patients were on hemodialysis, 11 percent were diabetic and only one patient abused intravenous drugs. The most frequent complication was cardiac failure in 59 percent of cases, followed by renal failure in 32 percent and embolism in 28 percent. The most frequent causing organism was coagulase positive Staphylococcus in 35 percent. Blood cultures were negative in 28 percent of cases from the metropolitan region, in 56 percent of cases from the north and 38 percent of cases from the south. Echocardiographic diagnosis was done in 92 percent of cases. Aortic valve was involved in 42 percent and mitral valve in 29 percent. Successful antimicrobial treatment was achieved in 59 percent of patients. Thirty five percent of patients were subjected to surgical procedures with a 78 percent survival. Overall mortality was 29 percent. Univariate analysis identified sepsis, an age over 60 years and the presence of cardiac or renal failure as prognostic indicators of mortality. On multivariate analysis, the identified prognostic indicators were the presence of sepsis, renal failure, mitroaortic involvement associated to combined surgery and failure of antimicrobial treatment not associated to surgery. Conclusions: Subacute form is the most common presentation of infective endocarditis and rheumatic valve disease is the most common underlying cardiac lesion. The most frequent causing agent is coagulase positive Staphylococcus...